OBJECTIVES: Despite global advancements in disease reporting, the epidemiology of multiple sclerosis (MS) in Asia is not well reported.  MS rates in Asia are low compared to Europe and North America, but are now thought to be increasing.  Globally, the median prevalence of MS is 30/100,000.  Our goal is a systematic search of epidemiologic studies of MS in Asia to determine accurate epidemiologic and treatment cost estimates.   METHODS: This systematic review examined articles published in English over 20 years using MESH terms: MS, incidence, prevalence, mortality and costs in any Asian country.  Articles with evidence from population-based samples, based on clinically-defined or laboratory supported MS (e.g., McDonald criteria) diagnoses, and from major Asian countries were retained.  Costs were the 2008 estimates from the Global Economic Impact of MS. RESULTS: As in other continents, prevalence in Asia is higher in women than men.  In the largest country, China, prevalence rates of MS are low (1-2/100,000).  In Northern Japan, a much higher prevalence (8.6/100,000) was reported in 2002, an increase from 2.5 in 1975.  In Korea, with a population density similar to China, the prevalence was 3.5/100,000, similar to the 3.0/100,000 in Taiwan (2005).  Based on an annual cost per patient of $41,335 (USD international), 2008 estimated costs in China due to MS exceed $1 billion.  In Japan, with 10 times fewer people, the costs exceed $452 million. CONCLUSIONS: Data from many Asian countries is limited and often from case-series designed to review clinical characteristics.  Larger epidemiological and cost-based studies in various populations are still needed.  Recent evidence suggests a higher prevalence than previously thought, possibly a result of better ascertainment driven by increased diagnostic awareness.  This review supports the development of effective medications and additional research to better understand the unmet medical need and economic burden driven by MS in Asia.